Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK
A rise in the incidence of some autoimmune disorders has been described. However, contemporary estimates of the overall incidence of autoimmune diseases and trends over time are scarce and inconsistent. We aimed to investigate the incidence and prevalence of 19 of the most common autoimmune diseases...
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| Veröffentlicht in: | The Lancet (British edition) 2023-06, Vol.401 (10391), p.1878-1890 |
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| creator | Conrad, Nathalie Misra, Shivani Verbakel, Jan Y Verbeke, Geert Molenberghs, Geert Taylor, Peter N Mason, Justin Sattar, Naveed McMurray, John J V McInnes, Iain B Khunti, Kamlesh Cambridge, Geraldine |
| description | A rise in the incidence of some autoimmune disorders has been described. However, contemporary estimates of the overall incidence of autoimmune diseases and trends over time are scarce and inconsistent. We aimed to investigate the incidence and prevalence of 19 of the most common autoimmune diseases in the UK, assess trends over time, and by sex, age, socioeconomic status, season, and region, and we examine rates of co-occurrence among autoimmune diseases.
In this UK population-based study, we used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex and ethnicity. Eligible participants were men and women (no age restriction) with acceptable records, approved for Hospital Episodes Statistics and Office of National Statistics linkage, and registered with their general practice for at least 12 months during the study period. We calculated age and sex standardised incidence and prevalence of 19 autoimmune disorders from 2000 to 2019 and used negative binomial regression models to investigate temporal trends and variation by age, sex, socioeconomic status, season of onset, and geographical region in England. To characterise co-occurrence of autoimmune diseases, we calculated incidence rate ratios (IRRs), comparing incidence rates of comorbid autoimmune disease among individuals with a first (index) autoimmune disease with incidence rates in the general population, using negative binomial regression models, adjusted for age and sex.
Among the 22 009 375 individuals included in the study, 978 872 had a new diagnosis of at least one autoimmune disease between Jan 1, 2000, and June 30, 2019 (mean age 54·0 years [SD 21·4]). 625 879 (63·9%) of these diagnosed individuals were female and 352 993 (36·1%) were male. Over the study period, age and sex standardised incidence rates of any autoimmune diseases increased (IRR 2017–19 vs 2000–02 1·04 [95% CI 1·00–1·09]). The largest increases were seen in coeliac disease (2·19 [2·05–2·35]), Sjogren's syndrome (2·09 [1·84–2·37]), and Graves' disease (2·07 [1·92–2·22]); pernicious anaemia (0·79 [0·72–0·86]) and Hashimoto's thyroiditis (0·81 [0·75–0·86]) significantly decreased in incidence. Together, the 19 autoimmune disorders examined affected 10·2% of the population over the study period (1 912 200 [13·1%] women and 668 264 [7·4%] men). A socioeconomic gradient was evident across several disease |
| doi_str_mv | 10.1016/S0140-6736(23)00457-9 |
| format | Article |
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In this UK population-based study, we used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex and ethnicity. Eligible participants were men and women (no age restriction) with acceptable records, approved for Hospital Episodes Statistics and Office of National Statistics linkage, and registered with their general practice for at least 12 months during the study period. We calculated age and sex standardised incidence and prevalence of 19 autoimmune disorders from 2000 to 2019 and used negative binomial regression models to investigate temporal trends and variation by age, sex, socioeconomic status, season of onset, and geographical region in England. To characterise co-occurrence of autoimmune diseases, we calculated incidence rate ratios (IRRs), comparing incidence rates of comorbid autoimmune disease among individuals with a first (index) autoimmune disease with incidence rates in the general population, using negative binomial regression models, adjusted for age and sex.
Among the 22 009 375 individuals included in the study, 978 872 had a new diagnosis of at least one autoimmune disease between Jan 1, 2000, and June 30, 2019 (mean age 54·0 years [SD 21·4]). 625 879 (63·9%) of these diagnosed individuals were female and 352 993 (36·1%) were male. Over the study period, age and sex standardised incidence rates of any autoimmune diseases increased (IRR 2017–19 vs 2000–02 1·04 [95% CI 1·00–1·09]). The largest increases were seen in coeliac disease (2·19 [2·05–2·35]), Sjogren's syndrome (2·09 [1·84–2·37]), and Graves' disease (2·07 [1·92–2·22]); pernicious anaemia (0·79 [0·72–0·86]) and Hashimoto's thyroiditis (0·81 [0·75–0·86]) significantly decreased in incidence. Together, the 19 autoimmune disorders examined affected 10·2% of the population over the study period (1 912 200 [13·1%] women and 668 264 [7·4%] men). A socioeconomic gradient was evident across several diseases, including pernicious anaemia (most vs least deprived area IRR 1·72 [1·64–1·81]), rheumatoid arthritis (1·52 [1·45–1·59]), Graves' disease (1·36 [1·30–1·43]), and systemic lupus erythematosus (1·35 [1·25–1·46]). Seasonal variations were observed for childhood-onset type 1 diabetes (more commonly diagnosed in winter) and vitiligo (more commonly diagnosed in summer), and regional variations were observed for a range of conditions. Autoimmune disorders were commonly associated with each other, particularly Sjögren's syndrome, systemic lupus erythematosus, and systemic sclerosis. Individuals with childhood-onset type 1 diabetes also had significantly higher rates of Addison's disease (IRR 26·5 [95% CI 17·3–40·7]), coeliac disease (28·4 [25·2–32·0]), and thyroid disease (Hashimoto's thyroiditis 13·3 [11·8–14·9] and Graves' disease 6·7 [5·1–8·5]), and multiple sclerosis had a particularly low rate of co-occurrence with other autoimmune diseases.
Autoimmune diseases affect approximately one in ten individuals, and their burden continues to increase over time at varying rates across individual diseases. The socioeconomic, seasonal, and regional disparities observed among several autoimmune disorders in our study suggest environmental factors in disease pathogenesis. The inter-relations between autoimmune diseases are commensurate with shared pathogenetic mechanisms or predisposing factors, particularly among connective tissue diseases and among endocrine diseases.
Research Foundation Flanders.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(23)00457-9</identifier><identifier>PMID: 37156255</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Addison's disease ; Age ; Anemia ; Anemia, Pernicious - complications ; Autoimmune diseases ; Autoimmune Diseases - complications ; Autoimmune Diseases - epidemiology ; Celiac disease ; Celiac Disease - complications ; Celiac Disease - epidemiology ; Child ; Children ; Chronic conditions ; Clinical medicine ; Cohort analysis ; Cohort Studies ; Connective tissue diseases ; Connective tissues ; Diabetes ; Diabetes mellitus (insulin dependent) ; Diabetes Mellitus, Type 1 - complications ; Disease prevention ; Electronic health records ; Electronic medical records ; England ; Environmental factors ; Ethnicity ; Female ; Graves disease ; Graves Disease - complications ; Hashimoto's thyroiditis ; Humans ; Incidence ; Lupus ; Lupus Erythematosus, Systemic ; Male ; Mathematical analysis ; Men ; Middle Aged ; Multiple sclerosis ; Pathogenesis ; Pernicious anemia ; Population studies ; Population-based studies ; Prevalence ; Primary care ; Psoriasis ; Public health ; Regression analysis ; Regression models ; Rheumatoid arthritis ; Risk factors ; Seasonal variations ; Sex ; Sjogren's Syndrome ; Skin diseases ; Social Class ; Socioeconomic factors ; Socioeconomic status ; Socioeconomics ; Statistics ; Systemic lupus erythematosus ; Systemic sclerosis ; Thyroid ; Thyroid diseases ; Thyroid gland ; Thyroiditis ; Thyroiditis - complications ; Trends ; Women</subject><ispartof>The Lancet (British edition), 2023-06, Vol.401 (10391), p.1878-1890</ispartof><rights>2023 Elsevier Ltd</rights><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><rights>2023. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c492t-705bc347f17bc988fc78b869eea30f1ebf04472b6d8bdd104a1a806d6e06f1f53</citedby><cites>FETCH-LOGICAL-c492t-705bc347f17bc988fc78b869eea30f1ebf04472b6d8bdd104a1a806d6e06f1f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2821628891?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37156255$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Conrad, Nathalie</creatorcontrib><creatorcontrib>Misra, Shivani</creatorcontrib><creatorcontrib>Verbakel, Jan Y</creatorcontrib><creatorcontrib>Verbeke, Geert</creatorcontrib><creatorcontrib>Molenberghs, Geert</creatorcontrib><creatorcontrib>Taylor, Peter N</creatorcontrib><creatorcontrib>Mason, Justin</creatorcontrib><creatorcontrib>Sattar, Naveed</creatorcontrib><creatorcontrib>McMurray, John J V</creatorcontrib><creatorcontrib>McInnes, Iain B</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><creatorcontrib>Cambridge, Geraldine</creatorcontrib><title>Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>A rise in the incidence of some autoimmune disorders has been described. However, contemporary estimates of the overall incidence of autoimmune diseases and trends over time are scarce and inconsistent. We aimed to investigate the incidence and prevalence of 19 of the most common autoimmune diseases in the UK, assess trends over time, and by sex, age, socioeconomic status, season, and region, and we examine rates of co-occurrence among autoimmune diseases.
In this UK population-based study, we used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex and ethnicity. Eligible participants were men and women (no age restriction) with acceptable records, approved for Hospital Episodes Statistics and Office of National Statistics linkage, and registered with their general practice for at least 12 months during the study period. We calculated age and sex standardised incidence and prevalence of 19 autoimmune disorders from 2000 to 2019 and used negative binomial regression models to investigate temporal trends and variation by age, sex, socioeconomic status, season of onset, and geographical region in England. To characterise co-occurrence of autoimmune diseases, we calculated incidence rate ratios (IRRs), comparing incidence rates of comorbid autoimmune disease among individuals with a first (index) autoimmune disease with incidence rates in the general population, using negative binomial regression models, adjusted for age and sex.
Among the 22 009 375 individuals included in the study, 978 872 had a new diagnosis of at least one autoimmune disease between Jan 1, 2000, and June 30, 2019 (mean age 54·0 years [SD 21·4]). 625 879 (63·9%) of these diagnosed individuals were female and 352 993 (36·1%) were male. Over the study period, age and sex standardised incidence rates of any autoimmune diseases increased (IRR 2017–19 vs 2000–02 1·04 [95% CI 1·00–1·09]). The largest increases were seen in coeliac disease (2·19 [2·05–2·35]), Sjogren's syndrome (2·09 [1·84–2·37]), and Graves' disease (2·07 [1·92–2·22]); pernicious anaemia (0·79 [0·72–0·86]) and Hashimoto's thyroiditis (0·81 [0·75–0·86]) significantly decreased in incidence. Together, the 19 autoimmune disorders examined affected 10·2% of the population over the study period (1 912 200 [13·1%] women and 668 264 [7·4%] men). A socioeconomic gradient was evident across several diseases, including pernicious anaemia (most vs least deprived area IRR 1·72 [1·64–1·81]), rheumatoid arthritis (1·52 [1·45–1·59]), Graves' disease (1·36 [1·30–1·43]), and systemic lupus erythematosus (1·35 [1·25–1·46]). Seasonal variations were observed for childhood-onset type 1 diabetes (more commonly diagnosed in winter) and vitiligo (more commonly diagnosed in summer), and regional variations were observed for a range of conditions. Autoimmune disorders were commonly associated with each other, particularly Sjögren's syndrome, systemic lupus erythematosus, and systemic sclerosis. Individuals with childhood-onset type 1 diabetes also had significantly higher rates of Addison's disease (IRR 26·5 [95% CI 17·3–40·7]), coeliac disease (28·4 [25·2–32·0]), and thyroid disease (Hashimoto's thyroiditis 13·3 [11·8–14·9] and Graves' disease 6·7 [5·1–8·5]), and multiple sclerosis had a particularly low rate of co-occurrence with other autoimmune diseases.
Autoimmune diseases affect approximately one in ten individuals, and their burden continues to increase over time at varying rates across individual diseases. The socioeconomic, seasonal, and regional disparities observed among several autoimmune disorders in our study suggest environmental factors in disease pathogenesis. The inter-relations between autoimmune diseases are commensurate with shared pathogenetic mechanisms or predisposing factors, particularly among connective tissue diseases and among endocrine diseases.
Research Foundation Flanders.</description><subject>Addison's disease</subject><subject>Age</subject><subject>Anemia</subject><subject>Anemia, Pernicious - complications</subject><subject>Autoimmune diseases</subject><subject>Autoimmune Diseases - complications</subject><subject>Autoimmune Diseases - epidemiology</subject><subject>Celiac disease</subject><subject>Celiac Disease - complications</subject><subject>Celiac Disease - epidemiology</subject><subject>Child</subject><subject>Children</subject><subject>Chronic conditions</subject><subject>Clinical medicine</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Connective tissue diseases</subject><subject>Connective tissues</subject><subject>Diabetes</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Diabetes Mellitus, Type 1 - complications</subject><subject>Disease prevention</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>England</subject><subject>Environmental factors</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Graves disease</subject><subject>Graves Disease - complications</subject><subject>Hashimoto's thyroiditis</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lupus</subject><subject>Lupus Erythematosus, Systemic</subject><subject>Male</subject><subject>Mathematical analysis</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Multiple sclerosis</subject><subject>Pathogenesis</subject><subject>Pernicious anemia</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Prevalence</subject><subject>Primary care</subject><subject>Psoriasis</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Rheumatoid arthritis</subject><subject>Risk factors</subject><subject>Seasonal variations</subject><subject>Sex</subject><subject>Sjogren's Syndrome</subject><subject>Skin diseases</subject><subject>Social Class</subject><subject>Socioeconomic factors</subject><subject>Socioeconomic status</subject><subject>Socioeconomics</subject><subject>Statistics</subject><subject>Systemic lupus erythematosus</subject><subject>Systemic sclerosis</subject><subject>Thyroid</subject><subject>Thyroid diseases</subject><subject>Thyroid gland</subject><subject>Thyroiditis</subject><subject>Thyroiditis - complications</subject><subject>Trends</subject><subject>Women</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU-L1TAUxYMoznP0IygBNyNYTdI0ad2IDP4ZHHChA-5Cmtw6Gdqm5s_D99H8dqav4yzcuMrl8jvnhHsQekrJK0qoeP2VUE4qIWtxxuoXhPBGVt09tKNc8qrh8vt9tLtDTtCjGG9IoQRpHqKTWtJGsKbZod8Xs3EWZgMv8RJgr8dt1rPFxlfemBzCusJ-wDon76Ypz4Ctiz5YCBH7PQSc3ARHTX_A-kfRR_i1mURvnAfjZz85g2PSKcc3WOPFL3nUyfm56nWENe3ah1SIbA9rGGN4cuNYAOxm6_bOZj3GMuN0Dfjq82P0YCgLeHL7nqKrD--_nX-qLr98vDh_d1kZ3rFUSdL0puZyoLI3XdsORrZ9KzoAXZOBQj8QziXrhW17aynhmuqWCCuAiIEOTX2KzjbfJfifGWJSk4sGxlHP4HNUrKXlmELQrqDP_0FvfA5z-V2hGBWsbTtaqGajTPAxBhjUEtykw0FRotZu1bFbtRanWK2O3arV_dmte-4nsHeqv2UW4O0GQDnH3kFQ0bi1O-sCmKSsd_-J-ANEirXj</recordid><startdate>20230603</startdate><enddate>20230603</enddate><creator>Conrad, Nathalie</creator><creator>Misra, Shivani</creator><creator>Verbakel, Jan Y</creator><creator>Verbeke, Geert</creator><creator>Molenberghs, Geert</creator><creator>Taylor, Peter N</creator><creator>Mason, Justin</creator><creator>Sattar, Naveed</creator><creator>McMurray, John J V</creator><creator>McInnes, Iain B</creator><creator>Khunti, Kamlesh</creator><creator>Cambridge, Geraldine</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20230603</creationdate><title>Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK</title><author>Conrad, Nathalie ; Misra, Shivani ; Verbakel, Jan Y ; Verbeke, Geert ; Molenberghs, Geert ; Taylor, Peter N ; Mason, Justin ; Sattar, Naveed ; McMurray, John J V ; McInnes, Iain B ; Khunti, Kamlesh ; Cambridge, Geraldine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c492t-705bc347f17bc988fc78b869eea30f1ebf04472b6d8bdd104a1a806d6e06f1f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Addison's disease</topic><topic>Age</topic><topic>Anemia</topic><topic>Anemia, Pernicious - complications</topic><topic>Autoimmune diseases</topic><topic>Autoimmune Diseases - complications</topic><topic>Autoimmune Diseases - epidemiology</topic><topic>Celiac disease</topic><topic>Celiac Disease - complications</topic><topic>Celiac Disease - epidemiology</topic><topic>Child</topic><topic>Children</topic><topic>Chronic conditions</topic><topic>Clinical medicine</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Connective tissue diseases</topic><topic>Connective tissues</topic><topic>Diabetes</topic><topic>Diabetes mellitus (insulin dependent)</topic><topic>Diabetes Mellitus, Type 1 - complications</topic><topic>Disease prevention</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>England</topic><topic>Environmental factors</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Graves disease</topic><topic>Graves Disease - complications</topic><topic>Hashimoto's thyroiditis</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lupus</topic><topic>Lupus Erythematosus, Systemic</topic><topic>Male</topic><topic>Mathematical analysis</topic><topic>Men</topic><topic>Middle Aged</topic><topic>Multiple sclerosis</topic><topic>Pathogenesis</topic><topic>Pernicious anemia</topic><topic>Population studies</topic><topic>Population-based studies</topic><topic>Prevalence</topic><topic>Primary care</topic><topic>Psoriasis</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Rheumatoid arthritis</topic><topic>Risk factors</topic><topic>Seasonal variations</topic><topic>Sex</topic><topic>Sjogren's Syndrome</topic><topic>Skin diseases</topic><topic>Social Class</topic><topic>Socioeconomic factors</topic><topic>Socioeconomic status</topic><topic>Socioeconomics</topic><topic>Statistics</topic><topic>Systemic lupus erythematosus</topic><topic>Systemic sclerosis</topic><topic>Thyroid</topic><topic>Thyroid diseases</topic><topic>Thyroid gland</topic><topic>Thyroiditis</topic><topic>Thyroiditis - complications</topic><topic>Trends</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Conrad, Nathalie</creatorcontrib><creatorcontrib>Misra, Shivani</creatorcontrib><creatorcontrib>Verbakel, Jan Y</creatorcontrib><creatorcontrib>Verbeke, Geert</creatorcontrib><creatorcontrib>Molenberghs, Geert</creatorcontrib><creatorcontrib>Taylor, Peter N</creatorcontrib><creatorcontrib>Mason, Justin</creatorcontrib><creatorcontrib>Sattar, Naveed</creatorcontrib><creatorcontrib>McMurray, John J V</creatorcontrib><creatorcontrib>McInnes, Iain B</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><creatorcontrib>Cambridge, Geraldine</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News & ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Conrad, Nathalie</au><au>Misra, Shivani</au><au>Verbakel, Jan Y</au><au>Verbeke, Geert</au><au>Molenberghs, Geert</au><au>Taylor, Peter N</au><au>Mason, Justin</au><au>Sattar, Naveed</au><au>McMurray, John J V</au><au>McInnes, Iain B</au><au>Khunti, Kamlesh</au><au>Cambridge, Geraldine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2023-06-03</date><risdate>2023</risdate><volume>401</volume><issue>10391</issue><spage>1878</spage><epage>1890</epage><pages>1878-1890</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><abstract>A rise in the incidence of some autoimmune disorders has been described. However, contemporary estimates of the overall incidence of autoimmune diseases and trends over time are scarce and inconsistent. We aimed to investigate the incidence and prevalence of 19 of the most common autoimmune diseases in the UK, assess trends over time, and by sex, age, socioeconomic status, season, and region, and we examine rates of co-occurrence among autoimmune diseases.
In this UK population-based study, we used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex and ethnicity. Eligible participants were men and women (no age restriction) with acceptable records, approved for Hospital Episodes Statistics and Office of National Statistics linkage, and registered with their general practice for at least 12 months during the study period. We calculated age and sex standardised incidence and prevalence of 19 autoimmune disorders from 2000 to 2019 and used negative binomial regression models to investigate temporal trends and variation by age, sex, socioeconomic status, season of onset, and geographical region in England. To characterise co-occurrence of autoimmune diseases, we calculated incidence rate ratios (IRRs), comparing incidence rates of comorbid autoimmune disease among individuals with a first (index) autoimmune disease with incidence rates in the general population, using negative binomial regression models, adjusted for age and sex.
Among the 22 009 375 individuals included in the study, 978 872 had a new diagnosis of at least one autoimmune disease between Jan 1, 2000, and June 30, 2019 (mean age 54·0 years [SD 21·4]). 625 879 (63·9%) of these diagnosed individuals were female and 352 993 (36·1%) were male. Over the study period, age and sex standardised incidence rates of any autoimmune diseases increased (IRR 2017–19 vs 2000–02 1·04 [95% CI 1·00–1·09]). The largest increases were seen in coeliac disease (2·19 [2·05–2·35]), Sjogren's syndrome (2·09 [1·84–2·37]), and Graves' disease (2·07 [1·92–2·22]); pernicious anaemia (0·79 [0·72–0·86]) and Hashimoto's thyroiditis (0·81 [0·75–0·86]) significantly decreased in incidence. Together, the 19 autoimmune disorders examined affected 10·2% of the population over the study period (1 912 200 [13·1%] women and 668 264 [7·4%] men). A socioeconomic gradient was evident across several diseases, including pernicious anaemia (most vs least deprived area IRR 1·72 [1·64–1·81]), rheumatoid arthritis (1·52 [1·45–1·59]), Graves' disease (1·36 [1·30–1·43]), and systemic lupus erythematosus (1·35 [1·25–1·46]). Seasonal variations were observed for childhood-onset type 1 diabetes (more commonly diagnosed in winter) and vitiligo (more commonly diagnosed in summer), and regional variations were observed for a range of conditions. Autoimmune disorders were commonly associated with each other, particularly Sjögren's syndrome, systemic lupus erythematosus, and systemic sclerosis. Individuals with childhood-onset type 1 diabetes also had significantly higher rates of Addison's disease (IRR 26·5 [95% CI 17·3–40·7]), coeliac disease (28·4 [25·2–32·0]), and thyroid disease (Hashimoto's thyroiditis 13·3 [11·8–14·9] and Graves' disease 6·7 [5·1–8·5]), and multiple sclerosis had a particularly low rate of co-occurrence with other autoimmune diseases.
Autoimmune diseases affect approximately one in ten individuals, and their burden continues to increase over time at varying rates across individual diseases. The socioeconomic, seasonal, and regional disparities observed among several autoimmune disorders in our study suggest environmental factors in disease pathogenesis. The inter-relations between autoimmune diseases are commensurate with shared pathogenetic mechanisms or predisposing factors, particularly among connective tissue diseases and among endocrine diseases.
Research Foundation Flanders.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37156255</pmid><doi>10.1016/S0140-6736(23)00457-9</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2023-06, Vol.401 (10391), p.1878-1890 |
| issn | 0140-6736 1474-547X |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Addison's disease Age Anemia Anemia, Pernicious - complications Autoimmune diseases Autoimmune Diseases - complications Autoimmune Diseases - epidemiology Celiac disease Celiac Disease - complications Celiac Disease - epidemiology Child Children Chronic conditions Clinical medicine Cohort analysis Cohort Studies Connective tissue diseases Connective tissues Diabetes Diabetes mellitus (insulin dependent) Diabetes Mellitus, Type 1 - complications Disease prevention Electronic health records Electronic medical records England Environmental factors Ethnicity Female Graves disease Graves Disease - complications Hashimoto's thyroiditis Humans Incidence Lupus Lupus Erythematosus, Systemic Male Mathematical analysis Men Middle Aged Multiple sclerosis Pathogenesis Pernicious anemia Population studies Population-based studies Prevalence Primary care Psoriasis Public health Regression analysis Regression models Rheumatoid arthritis Risk factors Seasonal variations Sex Sjogren's Syndrome Skin diseases Social Class Socioeconomic factors Socioeconomic status Socioeconomics Statistics Systemic lupus erythematosus Systemic sclerosis Thyroid Thyroid diseases Thyroid gland Thyroiditis Thyroiditis - complications Trends Women |
| title | Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK |
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